Intravoxel incoherent motion imaging combined with diffusion kurtosis imaging to assess the response to radiotherapy in a rabbit VX2 malignant bone tumor model

Purpose To combine intravoxel incoherent motion (IVIM) imaging and diffusion kurtosis imaging (DKI) parameters for the evaluation of radiotherapy response in rabbit VX2 malignant bone tumor model. Material and methods Forty-seven rabbits with bone tumor were prospectively enrolled and divided into pre-treatment, considerable effect and slight effect group. Treatment response was evaluated using IVIM-DKI. IVIM-based parameters (tissue diffusion [Dt], pseudo-diffusion [Dp], perfusion fraction [fp]), and DKI-based parameters (mean diffusion coefficient [MD] and mean kurtosis [MK]) were calculated for each animal. Corresponding changes in MRI parameters before and after radiotherapy in each group were studied with one-way ANOVA. Correlations of diffusion parameters of IVIM and DKI model were computed using Pearson's correlation test. A diagnostic model combining different diffusion parameters was established using binary logistic regression, and its ROC curve was used to evaluate its diagnostic performance for determining considerable and slight effect to malignant bone tumor. Results After radiotherapy, Dt and MD increased, whereas fp and MK decreased (p < 0.05). The differences in Dt, fp, MD, and MK between considerable effect and slight effect groups were statistically significant (p < 0.05). A combination of Dt, fp, and MK had the best diagnostic performance for differentiating considerable effect from slight effect (AUC = 0.913, p < 0.001). Conclusions A combination of IVIM- and DKI-based parameters allowed the non-invasive assessment of cellular, vascular, and microstructural changes in malignant bone tumors after radiotherapy, and holds great potential for monitoring the efficacy of tumor radiotherapy.

Automated summary

The purpose of this study was to evaluate the radiotherapy response in a rabbit VX2 malignant bone tumor model using a combination of intravoxel incoherent motion (IVIM) imaging and diffusion kurtosis imaging (DKI) parameters. The results showed that the combination of IVIM and DKI parameters allowed for the non-invasive assessment of cellular, vascular, and microstructural changes in malignant bone tumors after radiotherapy, and had the potential for monitoring the efficacy of tumor radiotherapy.